Session Title: Fibromyalgia and Soft Tissue Disorders
Session Type: Abstract Submissions (ACR)
Despite wide use of corticosteroid injection in the treatment of soft tissue and articular disorders, there is little data about its efficacy. We conducted a retrospective study to evaluate the effectiveness of corticosteroid (CS) and local anesthetic (LA) injections for treatment of musculoskeletal disorders (MSD).
The study was conducted at VA NYHHS; Brooklyn facility. Patients 18-85 years old who underwent CS or LA injection for MSD were identified by billing codes. The patients were invited to participate in a 28-question telephone survey. Information was collected regarding informed consent, impact on pain using pain score (PS 0-10), patient global assessment (PGA 0-100, 0 very poor-100 very well), functional status (M-HAQ) and side effects. Additional data was obtained by chart review. Descriptive analysis of all data collected and comparison of PS and PGA before and after the procedure were conducted.
116 patients were included in the final analysis. The average patient age was 60 years old, 85.3% men and 14% women.
The procedures were performed by different specialties, Rheumatology (30.17%), Podiatry (28.45%), Orthopedics (17.24%), Physical Medicine and Rehabilitation (12.07%), and Pain Management (12.07%). The most common indications were knee osteoarthritis (20.68%), plantar fasciitis (15.92%), rotator cuff tendinitis/impingment (15.92%) and trigger finger (8.62%). LA were used in combination with CS in the majority of procedures (91.96%).
Patients’ overall satisfaction with their procedure was 85%. The average PS prior to the procedure was 8.6; post-procedure average PS decreased to 2.8 (p<0.001Wilcoxon signed rank test). 69.93% of patients reported immediate relief after the injection. PGA before and after the procedure improved from an average 24 to 75 (p<0.001Wilcoxon signed rank test). 87.9% of patients reported that they experienced improvement in functional status; patients reported improvement in the ability to dress (34%), ability to get in and out of bed (45%), ability to lift a cup to their mouth (24%), ability to walk outdoors on flat ground (50%), ability to turn regular faucets (23%), ability to get in and out of a vehicle (49%). 57.76% of patients reported less analgesic use after the procedure; the average benefit of the injection was 6.18 months (range 0-24 months). 25.86% of the patients had a second injection and 12.93% of the patients underwent surgery for the same MSD. No serious adverse effects were reported; 3 patients reported bruising, 1 patient mild bleeding with the injection, 3 patients reported skin changes and 1 uncontrolled hypertension afer the procedure. No infections were reported.
This retrospective study found that CS injections for MSD are associated with significant self-reported reduction in pain and improvement in functional status. There was high reported satisfaction with the procedures and benefits were long-lasting (average 6 months). Corticosteroid injections should be considered an important tool for clinicians treating musculoskeletal conditions. This study is limited by recall bias and diversity of procedures.
J. B. Toro,
D. M. Lazaro,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/efficacy-and-safety-of-joint-and-soft-tissue-injections-a-retrospective-study/